Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | N8620 | TX |
Y | 208000000X | Pediatrician | N8620 | TX |
NPI | 1386625135 |
---|---|
Provider Name | Marylou Buyse |
First Address | Dallas, TX 75284-7408 |
Second Address | Waco, TX 76710-1031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 05/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2035367 | (05) | MA |
E02008 | (02) |